Nepal: New research on populations most vulnerable to HIV

Nepal is a low HIV prevalence country with an estimated 64,000 persons who are living with HIV[1]. The country's HIV epidemic is mainly concentrated among Female Sex Workers (FSWs), Male Sex Workers, Transgenders and their Clients (MTCs) and Injecting Drug Users (IDUs), who form the most vulnerable or Most-at-Risk Population groups (MARPs). Reliable estimates of the sizes of MARPs have remained a big data gap in Nepal in recent years. To bridge this gap and lay the ground for a more robust and evidence informed response to HIV, the Government of Nepal-through the HIV/AIDS and STI Control Board (HSCB) and National Centre for AIDS and STD Control (NCASC)-undertook a mapping and size estimation exercise of MARPs in the country.

This exercise was conducted under the leadership of the HSCB and NCASC with financial and technical support from UNAIDS, World Bank, UNDP, UNODC and FHI Nepal/USAID with close oversight and monitoring by the Steering Committee. A three-part report, covering each of the three MARP groups was published. In particular, UNODC together with Recovering Nepal (a network of people who use drugs), provided technical and financial support for the mapping and size estimation of IDUs. UNODC was also a member of the steering committee and provided feedback and inputs on the research design and methodology.

IDUs are a population group which accounts for the largest proportion of people living with HIV in Nepal. Estimating their size poses a
significant challenge since most IDUs are hidden, owing to the stigma and discrimination associated with drug use.

The aim of the mapping and size estimation was to develop comprehensive maps of IDU sites, estimate the size of IDUs at district and national levels and to study the IDU behavioural and background characteristics. The mapping and size estimation exercise was conducted in 31 selected districts in 6 epidemic regions of the country: Highway districts, Kathmandu Valley, West and Mid West hills, Far Western Hills, Eastern Hills and Remaining Hills regions.

According to the
report, a total of 728 hotspots were identified in 357 different locations in the survey sites and as per the mapping and size estimation exercise in these hotspots, the number of IDUs in Nepal are between 30,155 and 33,742. 61.6% - the maximum proportion of IDUs in Nepal are reportedly aged between between 20-29 years. A total of 38% of IDUs started injecting drugs before reaching the age of 20.

The report presents the demographic profile of the interviewed IDUs in terms of characteristics including age, educational qualification, marital status, and behavioural characteristics, such as sexual habits and drug injecting practices. It also carries an analysis of current programme interventions for IDUs including the current coverage of sites for needle exchange, condom outlets, Voluntary Counselling and Testing (VCT) and/or Sexually Transmitted Infections (STI) service centres in IDU hotspots. Finally, it also gives a set of programmatic recommendations.

A similar mapping and size estimation exercise has been done for the other two MARP groups (
FSWs and
MTCs) also.